Provider Demographics
NPI:1013748219
Name:ZAMBRANO ROBLEDO, JORGE ANDRES (LPC MA)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ANDRES
Last Name:ZAMBRANO ROBLEDO
Suffix:
Gender:M
Credentials:LPC MA
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:
Other - Last Name:ZAMBRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:3625 CHOLLA CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0418
Mailing Address - Country:US
Mailing Address - Phone:720-708-9163
Mailing Address - Fax:
Practice Address - Street 1:745 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1066
Practice Address - Country:US
Practice Address - Phone:720-708-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional